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Nerve Block vs Discogram for Diagnosis

CoyoteCCoyote Posts: 120
edited 06/11/2012 - 8:42 AM in Spinal Injections
I recently posted that I had "failed" my discogram - i.e. I have an mri showing mild disc herniation/loss of height at L4-L5, but when they tried to provoke pain (the discogram) in the herniated disc and the adjacent healthy discs I felt no pain whatsoever in ANY of the discs.

I did the discogram to see if I qualified for surgery - I am seeking surgery AS A LAST RESORT - NOTHING ELSE HAS WORKED (over the past 3 years I have tried EVERYTHING). I have some of the pain from facet joints, but this does not account for all of the pain (I had a series of facet joint injections).

The surgeon said I might have been too sedated during the discogram and that's why I didn't feel anything. So he wants be to get another discogram with less sedation. I'm a bit dubious, because if they hit the sweet spot for the pain - it would have been like sticking a drill straight into the nerve of a tooth - I know I would have felt it - even if they gave me heroin!

I don't really want a discogram AGAIN because it's really kind of a big deal procedure, and I knocked my front tooth out last time - I fainted after the procedure. My tooth got jammed in again, but it was a pretty powerful experience.

Anyway - just read on this site about Nerve Blocks as a diagnostic tool. I have had epidural steroid injections and facet joint injections - but no-one ever told me to keep a diary of what I can and can't do, etc. for the few hours after the procedure. The epidural steroid injection (ESI) I had was the only thing that ever made me feel better - but only lasted a week. I'm wondering if a nerve block would help determine the source of my pain. Are nerve blocks and ESI's the same?

Thanks for any input any of you can give me.



  • I guess the answer would be "yes and no." And, in part, it depends on the doctor doing the procedure. A nerve block often contains a steroid medication as well as a numbing agent. As you mentioned, the needle is placed close to the suspected nerve root, and the medication is injected. There should be an immediate numbing effect. The patient is watched for the required recovery time, and then is asked to go about daily activities that normally provoke pain. If there is no pain, it is assumed that they have found the pain generator. Pain will increase as the numbing medication wears off. If a steroid is also included in the mix, at this point, the injection would begin to function like your typical ESI.

    If the patient goes about daily activities and maybe does even more than usual, and there is pain almost immediately, they can assume that the injected nerve is not the pain generator.

    This is a way to add to information when trying to figure out which nerve may be causing the pain symptoms. It does not really serve the same purposes as a discogram. I suppose it could in some cases, but I don't believe a nerve block would be ordered for the same purposes as a nerve block.

    Usually a discogram is ordered prior to surgery when the doctor is trying to ascertain which disc is the pain generator. The doctor is trying to determine if the disc itself is leaking or damaged. Sometimes a disc will not appear damaged on the MRI, but when injected, it will reveal an annular tear, or something that is not readily noticeable on the MRI. The discogram provides information pertaining to the disc.

    There are reasons other than a bad disc that cause nerve damage. A nerve block is usually not used to determine information about a disc because it wouldn't really indicate much.

    I hope this makes sense.

  • Thanks Gwennie, for taking the time to clear this up for me - as best as it can be cleared up, because all these tests seem a little vague and iffy. I guess I'll just have to have another Discogram.
    Thanks again.
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  • I'm sorry but I don't remember your earlier posts. What are your symptoms and what have you tried thus far?
  • I hurt my back 3 years ago on a roller-coaster ride and I've never gotten better. I have a mild herniation/loss of signal and height - it's very clear on the MRI - L4-L5 is a little black blur - all the other discs are fluffy white clouds. All my bones are perfect, although recently a doctor said I had a bit of facet joint hypertrophy.

    I've had all kinds of pills ( mobic, ibuprofin, oral steroids, celebrex, tramadol, tizanidine. I take Lyrica now, and mega-ibuprofin and oxycodeine for breakthrough pain); ESI's; facet joint injections x 3; 3 x regular PT; 1 x "special/gentle" PT; - the only thing that really touched the pain was the first ESI; but then the second ESI caused sooooooo much pain + made my menstruation a nightmare for about 2-3 months, so I never had a third.

    My symptoms? All movements I do cause pain in my back and the more I do, the more pain I experience, until after a few hours I can only stand and walk holding onto something. Or, I can do too much one day (e.g. go visit a friend and sit around for anything more than 5 hours) and then I can't leave the house for three days for pain. Pain is in the back, but it's like a great band that pulls me down. I also have acute episodes where I hurt my back - getting out of the bath, opening a door, bending over - and then I'm in agony about 3 days, and it takes me about 4 weeks to get back to baseline. My leg aches, and increasingly, so does my foot, but the pain that cripples me is the back pain. I manage daily activities by taking breaks - e.g. I can cook simple meals, but I need to sit down every 15 mins. Can't work, carry anything, clean floors, do laundry.

    I've been to three surgeons - this one will give me a fusion, but I said I didn't want surgery until I knew exactly where the pain was coming from. So that's why he said have another discogram.

    Thanks, Gwennie.
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